Red cell alloimmunization to rhesus antigen among pregnant women attending a tertiary care hospital in Oman

Objectives: The detection of maternal alloimmunization against red cell antigens is vital in the management of hemolytic disease of the fetus and newborn. We sought to measure the presence of allosensitization to Rhesus D [RhD] antibodies in antenatal women attending a tertiary care hospital and assess the fetal outcome in sensitized women

Methods: We conducted a retrospective review of pregnant Omani women who registered at the Sultan Qaboos University Hospital between June 2011 and June 2013. Pregnant women were tested for ABO blood type and were screened for RhD antigen and antibodies at their first antenatal clinic visit. In women who tested positive for the RhD antibodies, an antibody titer was performed to evaluate the severity of their case

Results: Data was available on 1,251 pregnant women who were managed and delivered at Sultan Qaboos University Hospital. The prevalence of RhD negative pregnant women was 7.3%. Blood group O was the most common followed by A, B, and AB. The rate of RhD negative alloimmunization was 10%, and anti-D was the most common antibody detected. There were no stillbirths or neonatal deaths. Postnatal transfusion was necessary for only one baby

Conclusions: The prevalence of RhD negativity was comparable to other Asian countries. Previous RhD alloimmunization and history of miscarriages were the most common maternal medical history

Use of intracervical foley catheter for induction of labour in cases of previous caesarean section experience of a single tertiary centre in Oman

Objectives: This study aimed to evaluate rates of success and perinatal complications of labour induction using an intracervical Foley catheter among women with a previous Caesarean delivery at a tertiary centre in Oman

Methods: This retrospective cohort study included 68 pregnant women with a history of a previous Caesarean section who were admitted for induction via Foley catheter between January 2011 and December 2013 to the Sultan Qaboos University Hospital, Muscat, Oman. Patient data were collected from electronic and delivery ward records

Results: Most women were 25-35 years old [76.5%] and 20 women had had one previous vaginal delivery [29.4%]. The most common indication for induction of labour was intrauterine growth restriction with oligohydramnios [27.9%]. Most women delivered after 40 gestational weeks [48.5%] and there were no neonatal admissions or complications. The majority experienced no complications during the induction period [85.3%], although a few had vaginal bleeding [5.9%], intrapartum fever [4.4%], rupture of the membranes [2.9%] and cord prolapse shortly after insertion of the Foley catheter [1.5%]. However, no cases of uterine rupture or scar dehiscence were noted. Overall, the success rate of vaginal birth after a previous Caesarean delivery was 69.1%, with the remaining patients undergoing an emergency Caesarean section [30.9%]

Conclusion: The use of a Foley catheter in the induction of labour in women with a previous Caesarean delivery appears a safe option with a good success rate and few maternal and fetal complications

Maternal and fetal outcomes of triplet gestation in a tertiary hospital in Oman

The aim of this study was to describe the fetal and maternal outcomes of triplet gestation and to report on the maternal characteristics of those pregnancies in a tertiary care centre in Oman. A retrospective study was undertaken of all triplet pregnancies delivered at Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2011. Over the three-year study period, there were 9,140 deliveries. Of these, there were 18 triplet pregnancies, giving a frequency of 0.2%. The mean gestational age at delivery was 31.0 +/- 3.0 weeks, and the mean birth weight was 1.594 +/- 460 g. The most common maternal complications were preterm labour in 13 pregnancies [72.2%], gestational diabetes in 7 [39%] and gestational hypertension in 5 [28%]. Of the total deliveries, there were 54 neonates. Neonatal complications among these included hyaline membrane disease in 25 neonates [46%], hyperbilirubinaemia in 24 [43%], sepsis in 18 [33%] and anaemia in 8 [15%]. The perinatal mortality rate was 55 per 1.000 births. The maternal and neonatal outcomes of triplet pregnancies were similar to those reported in other studies

Perinatal outcome in pregnancies with extreme preterm premature rupture of membranes [Mid-Trimester PROM]

Preterm premature rupture of membranes [PPROM] is defined as the rupture of fetal membranes before 37 weeks. Extreme PPROM occurs before 26 weeks' gestation and can result in perinatal morbidity and mortality. The aim of this study was to study the perinatal outcomes of mothers with extreme PPROM. A retrospective cohort study of 44 consecutive pregnant women, presenting with PPROM before 26 weeks' gestation, was conducted from January 2006 to December 2011 at Sultan Qaboos University Hospital, Oman. Maternal and neonatal information was collected from medical records, and delivery and neonatal unit registries. Women with PPROM presenting after 26 weeks' gestation, those with multiple gestations, or other types of preterm deliveries were excluded from the study. Of the 44 preterm infants admitted to the Neonatal Intensive Care Unit, 24 [55%] survived, 7 [16%] died within 24 hours of birth, 9 [20%] were miscarried, and 4 [9%] were stillbirths. Neonatal sepsis and pulmonary hypoplasia were the major causes of death. Neonatal complications among the surviving infants included prematurity in 11 [46%], respiratory distress syndrome in 19 [79%], sepsis in 12 [50%], and low birth weight in 11 [46%]. The neonatal survival rate was significantly associated with the gestational age at delivery but not with the gestational age upon rupture of membranes. Extreme PPROM was associated with adverse perinatal outcomes. The results of this study will help obstetricians and neonatologists in counseling couples experiencing PPROM. Future studies of long-term neonatal morbidity should have larger sample sizes and include more hospitals

Spontaneous resolution of fetal and neonatal ascites after birth

Fetal ascites is an uncommon abnormality usually reported in relation to non- immunological causes. The prospect for fetal and neonatal mortality is high, particularly when the ascites develops before 24 weeks of gestation. The diminution of severe fetal ascites without intrauterine management, especially with an uncomplicated neonatal outcome, is unusual. We report a case of isolated fetal ascites detected at 20 weeks' gestation. All investigations carried out were normal. Consecutive ultrasound examination showed ascites at 20 weeks' gestation. A follow-up ultrasound examination at 6 months of age revealed complete recovery from the ascites. Spontaneous resolution of fetal ascites, with a good prognosis, can occur in cases with an idiopathic aetiology